The building where Esteban Santiago lived in the Fairview neighborhood of Anchorage. He is charged with killing five people and wounding six more at the Fort Lauderdale-Hollywood International Airport on Jan. 6. Credit Joshua Corbett for The New York Times

New Orleans Having been in the small capitol city of Juneau, Alaska within recent months, I have been wondering if some of the powers that be in state government have been holding their breath and waiting for the other shoe to drop after the terrible tragedy of a shooter flew in from Alaska, suddenly producing a gun in the baggage claim area of the Fort Lauderdale airport and killing five people and injuring six before lying down and waiting for the police hardly a week ago. The shoe has now dropped in The New York Times.

This horror has been thoroughly reported of course, as it should have been. A fairly recently discharged soldier who had even more recently turned himself into the FBI office in Anchorage in November because he believed the government was controlling his mind had been the shooter. The fact that this had happened in Anchorage and not Juneau or a smaller city in Alaska should have been a lucky break. The major state psychiatric facility is located in Anchorage, so he was able to turn himself in voluntarily, pretty much right on the spot. Had he been in Juneau for example, the intermediate facilities have been closed and whether he would have even gotten to Anchorage for even the minimal observation given, might not have happened. After four days he was released. There were no curbs on his access to firearms, and of course that’s another troubling question, but let’s just focus on mental health treatment and support for right now, because the horrible consequences of these multiple institutional failures are already clear enough.

Kirk Johnson writing in the Times is clear about the failure of Alaskan governmental authorities to provide for mental health consumers in the state, and therefore the community and public as well. He starts it out badly:

In Alaska when people are involuntarily committed for mental health treatment, the median length of stay, at only five days, is shorter than in almost any other state. Only Wisconsin has a shorter median commitment time, at four days, according to the Treatment Advocacy Center, a national group that works to improve mental health laws and care. The national average is 75 days, with some states, like California, having a median of more than four months.

But then it just gets worse:

The mental health needs are great here, too. Alaska has the nation’s second-highest suicide rate, after Wyoming, and some rural areas are by far the worst in America in rates of self-harm, federal figures say. Alaska also has among the highest rates of adult binge drinking, according to federal figures. A study by the Kaiser Family Foundation ranked it 47th among states and territories in terms of the percentage of mental health care needs being met. At the same time, the number of beds at the Alaska Psychiatric Institute in Anchorage, the state’s only long-term psychiatric hospital, is now half of what it was in the early 1990s, though many other states also cut their mental health treatment systems during the Great Recession.

Admittedly, and the Times acknowledges this, Alaska started dealing with mental health needs only when it transitioned from a US territory to a full-fledged state. Congress ceded one-million acres as part of the transfer of lands to the state to create the Mental Health Trust in order to use the resources of those assets to create the mental health system virtually from scratch. The Times credits the Trust with lobbying for expansion of Medicaid benefits under Obamacare in the state, but didn’t detail the scandals in the first decades of the Trust’s operation that led to the courts forcing reforms or the current confusing upheaval in the Trust’s management and operations, all of which have left people questioning what is really going on with the Trust.

Alaska’s mental health consumers organized MCAN, the Mental Health Consumers’ Action Network, last year which has broad agenda which includes pushing the Trust for more transparency and accountability, as well as better provision of services and support for the mental health community, but with the shooting in Fort Lauderdale state government and the Trust officials both have to be squirming, because it is now crystal clear and beyond any question that mental health needs to be a top priority in the state and is a job undone and woefully handled. Not only are Alaska’s consumers demanding action, but the rest of the country is now clear that Alaska needs to step up, and its failure to do so, risks all Americans, as well as its own citizens.